Obstetrics is the field of medicine which encompasses the care of a woman during pregnancy and childbirth. In that way it is very unique, as when assessing these patients, your actually also assessing another the child. Consequently, the approach to history taking in Obstetrics whilst similar to other fields of medicine, includes a number of additional components.

The following is a guide to taking an Obstetric History, that will ensure you miss none of the key components.

Presenting Complaint
What is the problem that brought you to the hospital/clinic?

Some common presenting complaints include;

◘ Bleeding

◘ Abdominal Pain

◘ Hypertension

◘ Physiological complaints due to pregnancy

The patient may also be presenting as part of standard antenatal care (as per your local guidelines).

History of Presenting Complaint
Often there will be overlap between the history of the presenting complaint and the history of the current pregnancy.

History of Current Pregnancy
The history of current pregnancy should ideally be considered by the different trimesters to date. This will be useful for understanding common issues that arise at each stage, and also determining appropriate antenatal care and management.

General Questions

◘ Last menstrual Period (LMP)

◘ Estimated delivery date and approximate Gestational Age.

◘ Any concerns about your pregnancy

◘ What are your expectations regarding your pregnancy

First Trimester

◘ Further details regarding menstrual history (as below)

◘ Was the Pregnancy planned?

◘ How was the pregnancy confirmed?

◘ Signs and symptoms of pregnancy.

◘ How/has the pregnancy been dated (e.g. dating Ultrasound Scan)?

◘ What tests and scans have you had to date?

◘ Current medical illnesses and medications.

Second Trimester

◘ Any problems during second 3 months?

o Bleeding, vaginal discharge, urinary problems and so on.

◘ Last visit to the doctor?

o Has an Ultrasound scan (e.g. morphology scan) been done?

o Blood tests to date?

o Blood pressure?

o Growth of foetus, placenta location.

Third Trimester

◘ Any issues after the first 6 months of your pregnancy?

o Bleeding, vaginal discharge, urinary problems, labour pain.

o Blood pressure

o Glucose

o Test results

◘ Any plans or ideas about method of delivery.

Past Obstetric HistoryGravidity: the number of times a woman has been pregnant, regardless of the outcome.Parity: the number of times a female has given birth to a baby.

There are many different methods and protocols by which Gravidity and Parity are denoted, please be aware of your local policy and documentation guidelines.

A woman who has never given birth is a nullipara, a nullip, or para 0.
A woman who has given birth two or more times is multiparous and is called a multip.
A woman in her first pregnancy and who has therefore not yet given birth is a nullipara or nullip. After she gives birth she becomes a primip.

A woman who has given birth once before is primiparous, and would be referred to as a primipara or primip.

Details of each pregnancy

◘ Dates of deliveries

◘ Length of pregnancies

◘ Singleton/twin and so on

◘ Induction of labour/Spontaneous

◘ Mode of Delivery

◘ Weight of babies

◘ Gender of babies

◘ Complications before, during and after delivery

Number of miscarriages, terminations and/or ectopics – with appropriate details.

◘ This question should be asked as some patients will not consider the above situations as pregnancy.

Any difficulties conceiving and any treatment/management to date for sub-fertility.

Past Gynaecological History
If it hasn’t been so already, you should first gain a Menstrual History as appropriate.

◘ 1st day of last menstrual period

◘ Duration and regularity of normal cycle

◘ Flow: heavy/light, clots, number of tampons/pads used

◘ Pain

Last Cervical Smear (Pap Smear): when and results.

Any Gynaecology Surgery?

◘ D&C

◘ Loop excision of transitional zone (LETZ)

◘ Previous C-Sections

Treatment or investigations for; ectopic pregnancy, pelvic inflammatory disease, infertility
This may be an appropriate place to take a Sexual History (see sexual history for further details).

Past Medical & Surgical History
Current or past illnesses

◘ Hypertension

◘ Diabetes

◘ Epilepsy

◘ Thyroid (hypo or hyper)

◘ Thromboembolic disease

◘ Asthma

Hospital Admissions: when, where and why.
Surgical procedures

◘ when, where, why and details concerning procedure

◘ abdominal or gynaecological procedures

◘ problems with anaesthesia

◘ problems with bleeding (requiring transfusion) or clotting

Vaccinations/immunisations up to date?

Current Medications & Allergies
Medications can be divided into prescribed medications and non-prescribed medications/herbal remedies. The latter should not be missed, and approached in non-judgemental way.
Allergic to any medications?

IVLine has been running for a nearly 4 years now (or basically the length of my medical degree), and it's been a great journey to date. However, with every year that passes IVLine looks a little older and it now seems that IVLine requires a bit of a facelift.

It's time for a makeover.

This means a whole new IVLine is going to you in 2014. For starters say goodbye to IVLine.info and say hello to IVLine.org. Don't worry you'll still be able to access the site by IVLine.info, however if you have any pages bookmarked you'll have to change them.

What other features are planned?
Firstly, I'll be updating the design of the site so it's responsive. That is, it will adapt to suit your device; whether it be Computer, Laptop, Tablet or Smartphone.

Secondly, I'm not just about turning an ugly duckling into a pretty face. The site structure and navigation system is going to get a revamp.

Thirdly, out with the Blogger Commenting System and in with Disqus. This will make it easier for more people to comment and facilitate conversations.

There is much more coming in 2014, but I will leave you with the above for now.

Temporary Hiatus
To achieve all of this IVLine will be temporarily shutdown from the 25th December 2013 to the 1st January 2014.

A small collection of Obstetric summaries that I made whilst studying for my exams, that I thought would share with the greater world. They cover aspects like clinical features, investigations, risk factors and basic management.

If something is wrong with any of them let me know and I'll make a note of it here. They're all solo takes, so it may seem a little all over the place with plenty of 'ums' and 'ahhs'.

Preterm Labour

Just a note, though I didn't state it preterm labour is obviously labour before term.

JAM aka Just A Minute Medicine is a concept of quickly presenting the most pertinent facts in a video format. They are designed to act as quick refreshers of the most important information, that will guide clinical practice.

It's been over 3 and half years seen I wrote my original Top Online Resources for Medical Students, and we have come a long way. While there are still some of the old-favourites hanging around, there are also a whole bunch of newcomers to the online sphere.

So after initially writing a list at the start of medical school, I'm now writing one at the end. This is by no means a comprehensive list, rather a list of resources that I found particularly useful throughout my medical school life. Feel free to add you own top resources in the comments section below.

Please note the majority of resources included in this list are all freely available, however
some more comprehensive options do exist that require
payment/subscription. I also recommending checking what online resources are
provided by your Medical School/Hospital.

Lifeinthefastlane (LITFL) is one of my all time favourite resources, and probably the one I've used most on a regular basis. LITFL is a blog targeted at sharing emergency medicine and critical care knowledge, yet it's whole library of posts offers up much more to the reader.

Due to it's awesomeness, I'm not going waste any more time apart from saying, Go Check It Out!

The Global Medical Education Project (covered in a previous post) is a repository of medical information, images, videos and questions. It is an interactive network allowing people to tag media, vote questions up and down and comment on work.

An Evidence Based Medicine (EBM) website evaluating therapies and diagnostics. It is a useful resource to use to see an overview of the evidence behind different therapies and diagnostics. Cover a range of specialities from Cardiology through to Urology.

SketchyMedicinewww.sketchymedicine.com
I'm a very visual learner and SketchyMedicine is one of the blogs I frequently stop by to have a look.
There are some great doodles that cover a number of aspects of medicine; everything from internal medicine through to basic anatomy.

Khan Academywww.khanacademy.org
Khan Academy is a huge educational initiative comprising of 100s of videos. Best used for learning your basic sciences, or maybe just learning something new entirely.

You can also access their library on your mobile or tablet through the KhanApp.

Handwritten Tutorials www.handwrittentutorials.com
Simple. Handwritten video tutorials on basic physiology and anatomy. If you're a visual learner like me than these are high yield.

Lab Tests Online http://www.labtestsonline.org.au/
Labs tests online helps the clinician understand clinical laboratory tests. It provides information on individual tests (e.g. eLFTs), on tests for diagnosing or asessing (e.g. Anaemia) and tests for certain population groups (e.g. neonates). It contains information that has been localised to more than 15 different countries (from Australia through to the United States of America).

BioDigital Human https://www.biodigitalhuman.com/home/
The BioDigital Human is a virtual 3D body that brings to life thousands of medically accurate anatomy objects and health conditions in an interactive Web-based platform.

Zygote Body http://www.zygotebody.com/
An offshoot of the original GoogleBody, Zygote body provides another 3D view of the human body.

AnatomyZone http://www.anatomyzone.com/
AnatomyZone harnesses some of the above resources to create Anatomy tutorials useful to a wide range of different users, from nurses, to physiotherapists, to osteopaths, to medical students.

Clinical ExaminationThe Stanford Medicine 25http://stanfordmedicine25.stanford.edu/the25
This website produced by Stanford covers 25 common clinical examinations. It includes the usual collection of text, images and videos.

GeekyMedicshttp://geekymedics.com
A popular site amongst many medical students, GeekyMedics covers the basics of history taking and clinical examination in an easy and friendly way. Aside from their clinical examination posts, they also have a collection of posts relevant to OSCEs, Medicine, Surgery and Emergency.

There is also a clinical skills section on IVLine, which has a number of useful videos from the University of London.

CardiologyECGPediahttp://en.ecgpedia.org/
A free electrocardiography (ECG) tutorial and textbook to which anyone can contribute ,
pitched at medical professionals and keen medical students. Also includes a number of case studies.
If you're looking for a place to start in understanding ECG this is one I would recommend.

Profmontagehttp://www.profmontage.com.au
ProfMontage provides a video tutorial series on clinical cardiology, cardiac physiology and clinical epidemiology. The videos are short and snappy (being all less than 3 minutes) and features a cast of characters from Xtranormal.

Emergency Medicine
Note emergency medicine is renowned for a having very active group of clinicians and students worldwide publishing content. While I would love to include everyone on this list, I resorted to selecting just a few of my regulars. If you wish to find more it's worth checking out #FOAMed on twitter which is where all the emergency physicians spend their days.

AcademicLifeinEMhttp://academiclifeinem.com/
Academic Life in EM started by Michelle Lin (@M_Lin), provides a wealth of resources on Emergency Medicine topics. With consistently good content, this is not one to miss. My two personal picks from this site are; Tricks of Trade and her Paucis Verbis (PV) cards. The PV cards are available on iOS, Android, Evernote or Dropbox.

Patwari Academyhttp://www.youtube.com/user/oldblueday
If you haven't realised by now, I'm a bit of a visual learner. Patwari Academy is a series of video tutorials on emergency medicine and evidence based practice by Rahul Patwari. The videos are broken down into digestible bits, with often a topic like Advance Life Support running over a number of videos.

EMCrithttp://emcrit.org/
Scott Weingart (@EMCrit) the author of EMCrit, too many feels like the god of Critical Care. Not surprisingly his blog is a gold mine. While I wouldn't recommend this blog to kids just kicking off their medical training, this is one for anyone passionate about critical care.

Anatomy for Emergency Medicinehttp://emergencymedicineireland.com/anatomy-and-em/
Anatomy for Emergency Medicine is a podcast series which delivers doses of anatomical knowledge linked in with clinical scenarios. Often we learn anatomy simple as remember this goes here and does this. These podcasts series, ties our anatomical knowledge (or lack thereof) into the clinical scenarios some may face on a day to day basis.

Ultimate Guide to Traumahttp://www.ivline.org/2012/04/ultimate-guide-to-trauma.html
The Ultimate Guide to Trauma is a collection of posts from blogs like Lifeinthefastlane, Academic Life in EM, EMCrit and so on, which offers a starting point for those interested in understanding the approach to trauma in general and specific scenarios.

Shotgun Histologyhttp://www.youtube.com/user/WashingtonDeceit
Another long-standing favourite of medical students. Shotgun histology features selection of videos investigating the histology of different tissues. A
highly valuable resource for those who have had no experience in
histology. To watch in a series, view this playlist.

PathologyStudenthttp://www.pathologystudent.com/
Pathology Student's motto is 'making pathology easy and fun. While I can't comment on the fun part (being not a huge fan of pathology) it certainly makes it a bit easier and in my opinion bearable. Pathology student is regularly updated and has some useful study guides.

Clinical Cases http://clinicalcases.org/
Clinical Cases and Images is a useful resource that brings together various pearls of medical wisdom and aims to bridge the gap between clinical theory and practice. It is a well supported and recommended blog, having been featured in 14 peer-reviewed medical journals and other scientific publications.

Nephrology on Demand from the University of Eastern Carolina is a regularly updated website, with pearls, histopathology, videos and general renal goodness.

Precious Bodily Fluidshttp://www.pbfluids.com/
Handouts, powerpoints and a handful of blog posts since 2007, Precious Bodily Fluids is another a would recommend to get started with nephrology.

Neurology

Rather than do too much leg work, when I see a good resource I share it. Eve Purdy from Manu et Corde has put together a list of useful neurology resources.Draw it to know ithttp://www.drawittoknowit.com
Not exactly free (except for a free trial) and not strictly neurology, Draw it to know it is a site that gets you to draw neuroanatomy to remember it. I include it here, as I've found it useful at times; for both myself and students I've taught neuroanatomy too.

OphthalmologyOphthoBookhttp://www.ophthobook.com/
OphthoBook is what I would call the simple guide to Ophthalmology. In fact, for medical students I would probably just call it the complete guide. Written by Dr Tim Root, it contains some funky cartoon images, videos galore and all the basics you need to know about Ophthalmology.

The Eyes Have Ithttp://www.kellogg.umich.edu/theeyeshaveit/
An tutorial and quiz website provided by the University of Michigan. Though I like to think of it as an atlas with some questions. Best of all if you're looking to share all their content is licensed under creative commons.

OrthopaedicsAO Surgeryhttps://www.aofoundation.org/wps/portal/surgery
The AO Surgery Reference
is a huge online repository of surgical knowledge, consisting of more
than 7000 pages. It overviews surgical procedures, surgical decision
making, and has an abundance of images and videos Simply select an area of anatomy then work through Diagnosis, Indication, Preparation, Approach, Reduction & Fixation and Aftercare.

Wheeless' Textbook of Orthopaedicshttp://www.wheelessonline.com
To be honest I'm really not a fan of this site, but it gets recommended to me so often I've included it here. I'm sure the information is actually pretty good, but the layout and design, just make we want to stay well clear of this site.

PaediatricsRoyal Childrens Hospital (Melbourne)http://www.rch.org.au/clinicalguide/
A complete suite of clinical practice guidelines and tips developed by a team of paediatricians. Updated frequently and available on your mobile devices.

RadiologyRadiopaediahttp://radiopaedia.org/
A huge encyclopaedia of radiology knowledge. It has over 13000 cases, nearly 6000 articles which continues to all the time. Nearly anyone can be part of it, and it can accessed through their dedicated mobile apps.

Radiology Masterclass

http://www.radiologymasterclass.co.uk/
Whereas Radiopaedia feels like a reference site or wiki to all radiological knowledge, Radiology Masterclass has a structured tutorial breakdown. This allows you to work step-by-step through areas of firstly interest (e.g. by anatomy) followed by skill level.

Rural PracticeRural Doctors http://ruraldoctors.net/
This site is for clinicians who want to keep in touch with the latest in medical education concepts applicable to rural practice, listen to relevant podcasts and share thoughts on typical cases, using info from the wider medical education community.

SurgerySurgWiki.comhttp://surgwiki.com/
Surgwiki is brought to you by the ANZ Journal of Surgery and has a number of contributors and editors from across the globe. It is broken down into four main components; General concepts, Surgical technique, Peri-operative care and Specialty interests.

Subscription Services

Here are some paid services I particularly like.

BMJ Best Practice

MDConsult

AccessMedicine

I used to be a fan of Uptodate however it's not as useful to an Australian practitioner. In addition, BMJ Best Practice provides a great iPad App.

SummarySo that's a wrap-up of some of the resources I found most useful during my medical degree. I have obviously not had the chance to do every speciality throughout my years of training.And a few of the resources have obviously been due to their relevance to the Australian practitioner.

So I encourage everyone to share of their favourite below in the comments section or on twitter under #FOAMed.

So you have now purchased a purchased a bunch of apps, to enhance your
iPad to the next level. Yet now your iPad screens are starting to look a
little cluttered; Time to Organise. There are several ways in which you
can organise your apps and webclips (more on webclips in a future
episode), but Folders are the primary choice.

After getting your
iPad organised you may also wish to share the content on your iPad and
bring your home network content to your iPad. You can share music,
videos and much more between your iPad and home devices and we will show
how to set this up in today's episode.

Despite all the changes Apple has made to the Appstore, finding good quality medical apps can still be a challenge. This is where reviews and word of mouth play an important role in aiding health professionals find the gems amongst the rough. If you have been following the Pimp my iPad series, you will now have the basics down. Now it's time to start installing apps. If you can't hold out till next week's episode, I've included the first 30 reviewed apps from TechTool Thursday.

TechTool Thursday is a regular feature on LifeintheFastLane.com written by the knowledgeable Dr Tessa Davis (@TessaRDavis). Each week a new app is reviewed, looking at it's pro, cons, uses and where it could be improved.

Critical Medical GuideThe Barringer Group, LLC
Critical is an emergency medicine and general medicine reference app that provides the user with guidelines and information about treatment. It has a large range of resources including videos, images, calculators and scoring systems.

drawMD - FreeUrologyMatch
drawMD is a beautiful app for the iPad that allows you to explain
procedures and illnesses to your patients by using customised
diagramatic visual aids. The app provides templates for anatomical
explanations and you can customise these by adding extra stamps or your
own drawings.

EM Procedure LogBaker Hamilton
EM Procedure Log is a simple way of keeping a log of clinical activity. This can be procedures as the title suggests but could also be cases, presentations or other useful logs. Data is stored on the phone and can be shared via dropbox.

EM RashesEmergency Medicine Residents’ Association
EM rashes is designed to give the user an algorithm for quick diagnosis of rashes as they present in ED. The user answers a few simple questions about the rash & is taken to a page with information about the differential diagnoses.

LactMedNational Library of Medicine
LactMed provides information about the side effects of medicines when breastfeeding. The user searches for the drug they are prescribing and detailed results come back from the database about potential adverse effects.

MediBabbleNiteFloat, Inc
MediBabble is a translator app for clinicians to help communication with patients. Select the language, and then guide the patient through the clinical history and examination.

Medrills – AirwayArchieMD, Inc
Medrills Airway is a simulation app like no other. It is primarily aimed at paramedics but could be useful for ED medics too. The module provides instruction on good airway management followed by some simulated scenarios and questions to test and develop your skills.

palmPEDipalmER Worldwide LLC
palmPEDi provides quick access to important drug doses for paediatric emergencies. It’s all done by weight (or an estimated weight based on age). Select the weight and a long list of drug doses are at your feet (fingertips).

Paracetamol OverdoseIEDapps
Paracetamol Overdose is for assessing and managing paracetamol overdoses. It tells you how to assess risk, when to treat and gives you specific guidance based on your patient.

Pocket Eye ExamNOMAD
Pocket Eye exam is an app for testing eyes and for learning about the common ophthalmological assessments. It has been designed by Biomedical Engineering students and Neurologists.

PressorDex Emergency Medicine Residents’ Association
PressorDex is an app version of John Greenwood’s book, which is a handbook for treating critically ill patients. It contains guidance on medications, infusions, treatment, diagnosis and has inbuilt calculators.

RadiopaediaRadiopaedia Pty
Radiopaedia is a spin-off app from Radiopaedia.org. It allows the user to work through real-life patient cases and interpret their imaging results to come to a diagnosis. There is a mountain of information in the app if the user wants to learn more.

Resuscitation!EM Gladiators
Resuscitation! is a patient simulation resus game. A scenario is presented and you have to manage the patient exactly as would happen in an Emergency Department. A final score is awarded depending on your actions.

Reversing WarfarinHealthObs Ltd
Reversing Warfarin aims to help doctors manage their patients who are on warfarin. It gives specific and clear guidance about what do to when faced with a raised INR, a bleeding patient, or a patient heading to theatre.

SimMonitorMed-eSim Apps
SimMonitor allows simulation teaching without having to drag out mannequins and large monitors. Using just your iPhone you can provide a resus simulation experience providing ECG readings which you can adjust according to your student’s management.

UpshotClay Smith
Upshot is a new app by Keeping Up, providing the user with succinct summaries of recent research. The articles are digested and critically appraised, so a quick read is all that’s needed to keep up.

WoundSmartPocket Professions Inc
WoundSmart allows the user to keep track of patient wounds and document their progress. As well as storing serial photos of the wound, the user can also enter all the patient information; detailed medical history and specifics about the size and shape of the wound.

One the best features of the iPad is how easy it is to use from the
beginning. Anyone, from the technophiles, to children through to Orangutans
(http://www.youtube.com/watch?v=3KGrXZ...) can get use to simply navigating around the iPad.

Aside
from the simple and obvious controls Apple has built into the iPad,
there are also some hidden features and shortcuts that are great for
power users. In this episode will demonstrate how to use multitasking
gestures and shortcuts to be able to quickly navigate around your iPad.

Welcome

This blog seeks to investigate and share information on health issues, clinical and biomedical sciences, technology and my experiences of medical education along the way. It is purely for entertainment and anything here is not to be taken as medical adivce.

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